Overview

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

At the time of the inspection Bramble Home Care was providing personal care to 29 people. We spoke with eight people, a mixture of people who use the service and family members, to get their views on the care provided. We also observed staff on one visit.

Is the service safe?

People told us they felt safe with the staff who visited them. One person told us, “I feel safe – they’re nice people." One relative told us, “We had a gut feeling (about staff) and both have been good."

Safeguarding procedures were robust and staff were knowledgeable about how they would spot the signs of abuse and how they would report them.

We observed staff working with people in a way that respected people’s rights and dignity.

Staff knew about people’s risk management plans and these were discussed in the office throughout the day. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The staff planning the rotas took people’s care needs into account when making decisions about the skills and experience required. Staff had completed a range of training to support them in their roles. This helped to ensure that people’s needs were being met.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People who use the service and their relatives told us they were happy with the care they received and felt their needs were being met. One person told us, “The main reason they come is, I have medication I have to take because of my health problems and I’m inclined to forget things. They remind me." One relative told us, “They have her care plan and they know the situation."

In particular, people and their relatives made comments about the reliability of the service. The rota system in place ensured staff were given enough travel time between visits so they could reach their next appointment in good time. One relative told us, “We’re really chuffed, they actually keep to time and it makes a huge difference." One relative commented that staff were sometimes a bit too early to arrive but told us that this was the exception and they had brought the issue up with management, who were resolving it.

It was clear from our observations and from speaking with staff that they understood people’s care and support needs well.

Is the service caring?

We asked people and their relatives for their opinions about the staff that supported them. Feedback from people was positive, for example, “They’re friendly and approachable”, “They get along well with my wife”, “They look after (person)”, “They’re all very nice, chatty and willing to help”.

People using the service, their relatives and friends completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. One relative told us, “Before they started two people came to talk about mum….it was really nice, they asked about her life before she became ill – it was about the person."

We observed staff working sensitively with people, particularly with those who were less able to verbally communicate their wishes.

Is the service responsive?

On the day of our inspection we spoke with a district nurse who was visiting one person at their home because staff had alerted them to a problem with the person’s catheter. This meant the service worked well with other agencies and services to make sure people received care in a coherent way.

We noted that people’s care plans were reviewed regularly to ensure the care being provided was appropriate when people’s needs changed.

In particular, people who use the service and their relatives made comments about the flexibility of the service. One relative told us, “They’ve been very accommodating, quick and flexible. We changed the starting day." Another person told us “They’re very accommodating if I want something from the shops. Anything I want, they do it."

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Where issues arose these were escalated and actioned appropriately.

People made comments such as, “Everything’s fine – no complaints” and “I’m very pleased with the service I can’t think of any way it could be improved." People told us they felt able to raise issues with staff and felt these would be addressed. One relative told us “I’d phone the number on the folder if I had an issue."

The service had a quality assurance system in place, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. One relative told us, “At the core of what we do want is quality of care for mum and we’ve been very pleased with how it’s gone."

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.